Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders with significant individual and societal negative impacts of the disorder continuing into ...adulthood (Danielson et al. in Journal of Clinical Child and Adolescent Psychology,
in press
; Landes and London in Journal of Attention Disorders 25:3–13,
2021
). Genetic and environmental risk (e.g., modifiable exposures such as prenatal tobacco exposure and child maltreatment) for ADHD is likely multifactorial (Faraone et al. in Neuroscience & Biobehavioral Reviews 128:789–818,
2021
). However, the evidence for potentially modifiable contextual risks is spread across studies with different methodologies and ADHD criteria limiting understanding of the relationship between early risk factors and later childhood ADHD. Using common methodology across six meta-analyses (Bitsko et al. in Prevention Science,
2022
; Claussen et al. in Prevention Science 1–23,
2022
; Dimitrov et al. in Prevention Science,
2023
; Maher et al. in Prevention Science,
2023
; Robinson, Bitsko et al. in Prevention Science,
2022
; So et al. in Prevention Science,
2022
) examining 59 risk factors for childhood ADHD, the papers in this special issue use a public health approach to address prior gaps in the literature. This introductory paper provides examples of comprehensive public health approaches focusing on policy, systems, and environmental changes across socio-ecological contexts to improve health and wellbeing through prevention, early intervention, and support across development using findings from these meta-analyses. Together, the findings from these studies and a commentary by an author independent from the risk studies have the potential to minimize risk conditions, prioritize prevention efforts, and improve the long-term health and wellbeing of children and adults with ADHD.
In this article, the authors posit that programs promoting nurturing parent-child relationships influence outcomes of parents and young children living in poverty through two primary mechanisms: (a) ...strengthening parents' social support and (b) increasing positive parent-child interactions. The authors discuss evidence for these mechanisms as catalysts for change and provide examples from selected parenting programs that support the influence of nurturing relationships on child and parenting outcomes. The article focuses on prevention programs targeted at children and families living in poverty and closes with a discussion of the potential for widespread implementation and scalability for public health impact.
Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental ...disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study’s conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child’s likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children’s long-term developmental health.
Poor parental mental health and stress have been associated with children’s mental disorders, including attention-deficit/hyperactivity disorder (ADHD), through social, genetic, and neurobiological ...pathways. To determine the strength of the associations between parental mental health and child ADHD, we conducted a set of meta-analyses to examine the association of parent mental health indicators (e.g., parental depression, antidepressant usage, antisocial personality disorder, and stress and anxiety) with subsequent ADHD outcomes in children. Eligible ADHD outcomes included diagnosis or symptoms. Fifty-eight articles published from 1980 to 2019 were included. We calculated pooled effect sizes, accounting for each study’s conditional variance, separately for test statistics based on ADHD as a dichotomous (e.g., diagnosis or clinical cutoffs) or continuous measurement (e.g., symptoms of ADHD subtypes of inattentiveness and hyperactivity/impulsivity). Parental stress and parental depression were significantly associated with increased risk for ADHD overall and both symptoms and diagnosis. Specifically, maternal stress and anxiety, maternal prenatal stress, maternal depression, maternal post-partum depression, and paternal depression were positively associated with ADHD. In addition, parental depression was associated with symptoms of ADHD inattentive and hyperactive/impulsive subtypes. Parental antisocial personality disorder was also positively associated with ADHD overall and specifically ADHD diagnosis. Prenatal antidepressant usage was associated with ADHD when measured dichotomously only. These findings raise the possibility that prevention strategies promoting parental mental health and addressing parental stress could have the potential for positive long-term impacts on child health, well-being, and behavioral outcomes.
Background Research indicates that experiencing poverty in childhood increases risk for adverse medical and social outcomes across the lifespan. Evidence-based, parent-focused preventive group ...interventions such as Legacy for Children™ (Legacy) can improve developmental outcomes for at-risk children (Kaminski et al., 2013). Integrating parenting interventions into primary care clinics - trusted settings where families routinely access services - has been recommended to reduce barriers to participation and increase program uptake (Leslie et al., 2016). Program reach could be optimized through examination of participant, program, and organizational factors influencing implementation (Cates et al., 2016). Methods We examined factors influencing the implementation of the Legacy program in pediatric primary care. The Legacy sites (A and B) are funded through a Centers for Disease Control and Prevention and American Academy of Pediatrics cooperative agreement at two pediatric primary care clinics. Legacy representatives completed surveys at one (Y1) and two (Y2) years following initial implementation. Applying the framework method (Gale et al., 2013), we identified factors and analyzed themes relevant to implementation, specifically with respect to budget, participant retention, organizational barriers, facilitators and fit, and impacts within and across primary care sites over the two years. Results Sites reported similar types of implementation successes and challenges from Y1 to Y2. Different themes emerged across sites in relation to budget, participant retention, and organizational barriers and facilitators (Tables 1 and 2). Both sites reported hiring new staff each year, due to a desire to start new groups (Site A) or staff turnover (Site B). Both used incentives to retain participants, but Site A reported using a large variety of retention strategies. Across years, participant attrition was attributed to a number of factors- the most frequently reported was participant schedule conflicts. Both sites reported that organizational features facilitated implementation from Y1 to Y2, and both described staff characteristics (e.g., staff willingness to try new approaches) rather than agency characteristics (e.g., leadership buy-in) as facilitators of implementation. In describing implementation challenges, Site A reported logistical barriers (e.g., child care) whereas Site B described participant-level barriers (e.g., recruitment). Neither site reported sustainability actions in Y1 and Y2. Only Site B conducted an evaluation. Despite challenges, both sites recommended expanding Legacy and described alignment between Legacy and agency goals. From Y1 to Y2, Site B consistently reported that implementing Legacy in their agency may have helped participating mothers become more engaged advocates for their children's health. Conclusions Data from Legacy implementation indicate specific challenges and benefits to integration of Legacy in pediatric primary care clinics. Further research on parenting interventions within pediatric primary care clinics could inform solutions to common challenges, supporting the dissemination of this preventive approach and its ultimate public health impact (Leslie et al., 2016).
•The Legacy for ChildrenTM group-based parenting program can improve behavioral and socioemotional outcomes for families living in poverty, and has recently been culturally adapted for ...Spanish-speaking Latina mothers.•Spanish-speaking Latina mothers identified that their initial willingness to participate and engage in Legacy for ChildrenTM was influenced by program information provided and early interactions of group leaders with their children.•Spanish-speaking Latina mothers shared that sustained engagement in the parenting program was influenced by support from other Latina mothers in the program, perceived program benefits, childcare, incentives, logistical features, and group leader qualities and actions.•These data suggest that quality programming, facilitators of social connections, logistics (e.g., transportation, childcare) and group leader characteristics are important factors to consider for sustaining engagement of Spanish-speaking Latina mothers in parenting programs.
Culturally congruent parenting programs delivered during early childhood have the potential to support diverse families. Legacy for Children™ ( Legacy ) is a groupbased prevention program designed to promote child development by reinforcing sensitive, responsive mother-child relationships, building maternal self-efficacy, and fostering peer networks of support among mothers living in poverty (Perou et al., 2012). The Legacy program was translated and culturally adapted for Spanishspeaking Latina mothers and their infants with a feasibility trial conducted to determine the cultural congruency of the adaptation. Feasibility results were positive with no previous studies validating the adapted Legacy Spanish program. The current manuscript focuses on understanding factors of engagement of the culturally adapted model. Specifically, we examined the factors that were perceived to have enhanced or hindered both initial and sustained engagement in the adapted Legacy Spanish program for Latina mothers. Individual interviews were conducted with Latina mothers (N=26) who attended the Legacy Spanish program. We used qualitative data analysis to identify broad themes in Latina mothers’ responses. Themes emerged regarding the importance of using home-based recruitment strategies and pairing verbal information with written brochures to foster initial engagement. Sustained engagement themes focused on the provision of support from other Latina mothers in the Legacy group and the relationships with the group leaders. Having group leaders who were perceived as genuine, kind, positive, “good” at teaching, and persistent emerged as themes that facilitated initial and ongoing engagement. Barriers to engagement centered primarily on logistics rather than characteristics of the program itself. Thus, Latina mothers attributed importance to aspects of the curriculum, logistics, and implementation with respect to program engagement. Application of similar engagement strategies could enhance the success of early childhood parenting programs and linkages with early educational programming.
The objective of this article was to assess the impact on behavioral and socioemotional development, 4 to 6 years postintervention (depending on the curriculum), of Legacy for Children™, a public ...health approach to improve child developmental outcomes among families living in poverty.
Mothers who were recruited prenatally or at the time of childbirth participated in a set of Legacy parallel design randomized control trials between 2001 and 2009 in Miami, Florida, or Los Angeles, California. Of the initial 574 mother-child dyads, 364 completed at least 1 behavioral or socioemotional outcome measure at the third-grade follow-up. Intention-to-treat analyses compared Legacy and comparison groups on behavioral and socioemotional outcomes.
Children of Legacy mothers in Los Angeles were at lower risk for externalizing behaviors and poor adaptive skills than children whose mothers did not participate in the intervention. No significant outcome differences by group assignment were found in Miami.
Group-based positive parenting interventions such as Legacy may have a sustained impact on children's behavioral and socioemotional development several years after intervention completion.
Evidence suggests that caring for a child with special health care needs can affect many domains of family life, including caregiver mental health. However, few studies have examined these outcomes ...among families impacted by the Zika virus (ZIKV). This study examines depressive symptom severity and care demands among primary caregivers of children, aged 15 to 26 months, with evidence of congenital Zika virus infection (ZVI).
A sample of primary caregivers of children with evidence of congenital ZVI in northeastern Brazil (n = 150) reported on depressive symptoms, care demands, and their children's development. Children were categorized into groups according to their developmental delay status. Bivariate analyses were run to test for differences between groups. A path analysis model was used to examine the indirect effects of developmental delay on depressive symptoms through economic challenges and time spent providing health care at home and whether these associations varied by child care support.
Compared to primary caregivers of children without developmental delay, primary caregivers of children with developmental delay had higher depression scores (p = 0.002), reported more economic (p < 0.001) and child care (p < 0.001) challenges, and spent more time providing health care at home (p < 0.001). Among primary caregivers who did not have child care support, developmental delay had a significant indirect effect on depressive symptoms through economic challenges but not through time spent providing health care at home.
For families impacted by the ZIKV outbreak in Brazil, economic and child care challenges may be associated with primary caregiver mental health.
To assess the national and state prevalence of being “Healthy and Ready to Learn” (HRL) and associated sociodemographic, health, family and neighborhood factors.
Cross-sectional analysis of the 2016 ...National Survey of Children's Health, a nationally representative parent-reported survey administered by web and paper June 2016 to February 2017. Four domains were constructed from 18 items through confirmatory factor analyses: “Early Learning Skills”, “Social-Emotional Development”, “Self-Regulation”, and “Physical Well-being and Motor Development.” Each item and domain were scored according to age-specific standards as “On-Track”, “Needs Support”, and “At Risk” with overall HRL defined as “On-Track” in all domains for 7565 randomly selected children ages 3 to 5 years.
In 2016, 42.2% of children ages 3 to 5 years were considered HRL with the proportion considered “On-Track” ranging from 58.4% for Early Learning Skills to 85.5% for Physical Well-being and Motor Development”; approximately 80% of children were considered “On-Track” in Social-Emotional Development and Self-Regulation, respectively. Sociodemographic differences were mostly non-significant in multivariable analyses. Health, family, and neighborhood factors (ie, special health care needs status/type, parental mental health, reading, singing and storytelling, screen time, adverse childhood experiences, and neighborhood amenities) were associated with HRL. HRL prevalence ranged from 25.5% (NV) to 58.7% (NY), but only 4 states were significantly different from the U.S. overall.
Based on this pilot measure, only about 4 in 10 US children ages 3 to 5 years may be considered “Healthy and Ready to Learn.” Improvement opportunities exist for multiple, modifiable factors to affect young children's readiness to start school.
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